A systematic review and appraisal of the quality of practice guidelines for the management of Neisseria gonorrhoeae infections.

"Abstract:

BACKGROUND:Clinical guidelines help ensure consistent care informed by current evidence. As shifts in antimicrobial resistance continue to influence first-line treatment, up-to-date guidelines are important for preventing treatment failure. A guideline's development process will influence its recommendations and users' trust.

OBJECTIVE:To assess the quality of current gonorrhoea guidelines' development processes.

DATA SOURCES:Multiple databases.

STUDY ELIGIBILITY CRITERIA:Original and current English-language guidelines targeting health professionals and containing treatment recommendations for uncomplicated gonorrhoea in the general adult population.

STUDY APPRAISAL AND SYNTHESIS METHODS:Two appraisers assessed the guidelines independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Scores were combined as per the AGREE II users' manual.

RESULTS:We identified 10 guidelines meeting the inclusion criteria. The quality of the gonorrhoea treatment guidelines varied. Most scored poorly on Rigour of Development; information on the evidence review process and methods for formulating recommendations was often missing. The WHO Guidelines for the Treatment of Neisseria gonorrhoeae and UK National Guideline for the Management of Gonorrhoea in Adults scored the highest on Rigour of Development. Methods to address conflicts of interest were often not described in the materials reviewed. Implementation of recommendations was often not addressed.

LIMITATIONS:By limiting our study to English-language guidelines, a small number of guidelines we identified were excluded. Our analysis was limited to either published or online materials that were readily available to users. We could not differentiate between items addressed in the development process but not documented from items that were not addressed.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Gonorrhoea treatment guidelines may slow antimicrobial resistance. Many current guidelines are not in line with the current guideline development best practices; this might undermine the perceived trustworthiness of guidelines. By identifying current limitations, this study can help improve the quality of future guidelines."

The antibiotic management of gonorrhoea in Ontario, Canada following multiple changes in guidelines: an interrupted time-series analysis.

"Abstract:

OBJECTIVE:

This study assessed adherence with first-line gonorrhoea treatment recommendations in Ontario, Canada, following recent guideline changes due to antibiotic resistance.

METHODS:

We used interrupted times-series analyses to analyse treatment data for cases of uncomplicated gonorrhoea reported in Ontario, Canada, between January 2006 and May 2014. We assessed adherence with first-line treatment according to the guidelines in place at the time and the use of specific antibiotics over time. We used the introduction of new recommendations in the Canadian Guidelines for Sexually Transmitted Infections in 2008 and 2011 and the release of the province of Ontario's Guidelines for the Treatment and Management of Gonococcal Infections in Ontario in 2013 as interruptions in the time-series analysis.

RESULTS:

Overall, 34 287 gonorrhoea cases were reported between 1 January 2006 and 31 May 2014. Treatment data were available for 32 312 (94.2%). Our analysis included 32 272 (94.1%) cases without either a conjunctival or disseminated infection. Following the release of the 2011 recommendations, adherence with first-line recommendations immediately decreased to below 30%. Adherence slowly increased but did not reach baseline levels before the 2013 guidelines were released. Following release of the 2013 guidelines, adherence again decreased; adherence is slowly recovering but by May 2014, was only approximately 60%.

CONCLUSIONS:

Due to concerns about antibiotic resistance, gonorrhoea treatment guidelines need to be updated regularly and rapidly adopted in practice. Our study showed poor adherence following dissemination of updated guidelines. Over a year after the latest Ontario guidelines were released, 40% of patients did not receive first-line treatment, putting them at risk of treatment failure and potentially promoting further drug resistance. Greater attention should be devoted to dissemination and implementation of new guidelines."

Use of GetCheckedOnline, a Comprehensive Web-based Testing Service for Sexually Transmitted and Blood-Borne Infections.

"Abstract:

BACKGROUND:

The British Columbia Centre for Disease Control implemented a comprehensive Web-based testing service GetCheckedOnline (GCO) in September 2014 in Vancouver, Canada. GCO's objectives are to increase testing for sexually transmitted and blood-borne infections (STBBIs), reach high-prevalence populations facing testing barriers, and increase clinical STI service capacity. GCO was promoted through email invitations to provincial STI clinic clients, access codes to clients unable to access immediate clinic-based testing (deferred testers), and a campaign to gay, bisexual, and other men who have sex with men (MSM).

OBJECTIVE:

The objective of the study was to report on characteristics of GCO users, use and test outcomes (overall and by promotional strategy) during this pilot phase.

METHODS:

We used GCO program data, website metrics, and provincial STI clinic records to describe temporal trends, progression through the service pathway, and demographic, risk, and testing outcomes for individuals creating GCO accounts during the first 15 months of implementation.

RESULTS:

Of 868 clients creating accounts, 318 (36.6%) submitted specimens, of whom 96 (30.2%) tested more than once and 10 (3.1%) had a positive STI diagnosis. The proportion of clients submitting specimens increased steadily over the course of the pilot phase following introduction of deferred tester codes. Clients were diverse with respect to age, gender, and ethnicity, although youth and individuals of nonwhite ethnicity were underrepresented. Of the 506 clients completing risk assessments, 215 (42.5%) were MSM, 89 (17.6%) were symptomatic, 47 (9.3%) were STI contacts, 232 (45.8%) reported condomless sex, 146 (28.9%) reported ≥4 partners in the past 3 months, and 76 (15.0%) reported a recent STI. A total of 63 (12.5%) GCO clients were testing for the first time. For 868 accounts created, 337 (38.8%) were by clinic invitations (0 diagnoses), 298 (34.3%) were by deferred testers (6 diagnoses), 194 (22.4%) were by promotional campaign (3 diagnoses), and 39 (4.5%) were by other means (1 diagnosis).

CONCLUSIONS:

Our evaluation suggests that GCO is an acceptable and feasible approach to engage individuals in testing. Use by first-time testers, repeated use, and STI diagnosis of individuals unable to access immediate clinic-based testing suggest GCO may facilitate uptake of STBBI testing and earlier diagnosis. Use by MSM and individuals reporting sexual risk suggests GCO may reach populations with a higher risk of STI. Motivation to test (eg, unable to access clinical services immediately) appears a key factor underlying GCO use. These findings identify areas for refinement of the testing model, further promotion, and future research (including understanding reasons for drop-off through the service pathway and more comprehensive evaluation of effectiveness). Increased uptake and diagnosis corresponding with expansion of the service within British Columbia will permit future evaluation of this service across varying populations and settings."

An introduction to the healthy corner store intervention model in Canada.

"Abstract:

SETTING:

The majority of Canadians' food acquisition occurs in retail stores. Retail science has become increasingly sophisticated in demonstrating how consumer environments influence population-level diet quality and health status. The retail food environment literature is new but growing rapidly in Canada, and there is a relative paucity of evidence from intervention research implemented in Canada.

INTERVENTION:

The healthy corner store model is a comprehensive complex population health intervention in small retail stores, intended to transform an existing business model to a health-promoting one through intersectoral collaboration. Healthy corner store interventions typically involve conversions of existing stores with the participation of health, community, and business sector partners, addressing business fundamentals, merchandising, and consumer demand.

OUTCOMES:

This article introduces pioneering experiences with the healthy corner store intervention in Canada. First, we offer a brief overview of the state of evidence within and outside Canada. Second, we discuss three urban and one rural healthy corner store initiatives, led through partnerships among community food security organizations, public health units, academics, and business partners, in Manitoba, Ontario, and Newfoundland and Labrador. Third, we synthesize the promising practices from these local examples, including aspects of both intervention science (e.g., refinements in measuring the food environment) and community-based practice (e.g., dealing with unhealthy food items and economic impact for the retailer).

IMPLICATIONS:

This article will synthesize practical experiences with healthy corner stores in Canada. It offers a baseline assessment of promising aspects of this intervention for health and health equity, and identifies opportunities to strengthen both science and practice in this area of retail food environment work."

INTERVENTION:

Components of the Guidelines were piloted in 5 MCC sites prior to being launched in 10 MCC sites across Ottawa, Ontario. Two project Advisory Groups supported the development of the Guidelines. Staff training, resources, recipes and menus were provided. An evaluation was conducted and has informed the Guidelines' subsequent community implementation. In 2015, accompanying web-based resources and e-modules were developed.

OUTCOMES:

The evaluation demonstrated environmental and programming changes. Parent satisfaction was high and preliminary findings showed no real changes in food costs. Following implementation, the cooks reported high compliance to the 6-week menu plans provided, and the number of sites offering 120 minutes or more of daily physical activity increased.

IMPLICATIONS:

Through novel intersectoral partnerships, OPH was able to implement and evaluate HEAL Guidelines in tandem. The interdisciplinary project Advisory Groups, training of cooks, and engagement of the Ontario Coaches Association were all innovative elements of this project and may influence future public health activity in this area."

HIV medications can be used as post-exposure prophylaxis to efficaciously prevent an HIV-negative person who has come into contact with HIV from becoming HIV-positive. Traditionally, these medications have been available in emergency departments, which have constituted a barrier for the members of many minority groups who are greatly affected by HIV transmission (i.e. gay, bisexual and other men who have sex with men, and persons who use injection drugs). From 5 September 2013 through 4 September 2015, we sought to increase the use of HIV post-exposure prophylaxis by having registered nurses provide these medications, when indicated, in community clinics in Ottawa, Canada. We undertook a chart review of patients who accessed services for HIV post-exposure prophylaxis in this period. Over the two years of data collection, 112 persons requested HIV post-exposure prophylaxis and 64% (n = 72) initiated these medications. Most (93%, or n = 67, of the 72 initiations) were among men, with 88% (n = 59) of these men reporting same sex sexual partners. Among these 58 men, 31% (n = 18) had sexual contact with other men known to be HIV-positive. Among women (n = 8), five initiated post-exposure prophylaxis: three after needle-sharing contact or sexual contact with a male partner who reportedly shared needles, and two after unprotected vaginal sex with a male partner known to be HIV-positive. Overall, no one was diagnosed with HIV at the four-month HIV testing follow-up, although six persons were diagnosed with HIV from the baseline HIV testing, and an additional four were diagnosed with HIV during routine HIV testing one year after completing post-exposure prophylaxis. In total, nine persons in our sample were thus diagnosed with HIV during the study period, which accounted for 9.4% (n = 10 of 106) of all reported HIV diagnoses in Ottawa during this time. We conclude that nurse-initiated HIV post-exposure prophylaxis can be an effective way to provide HIV prevention services to persons who are at high-risk for HIV."

Public Attitudes Toward Breastfeeding in Public Places in Ottawa, Canada.

"Abstract:

BACKGROUND:

In Ontario, Canada, breastfeeding in public is a protected right, yet even with these laws, attitudes toward breastfeeding in public can serve as a barrier to breastfeeding. Research aim: This study assesses public support for breastfeeding in public among adults in Ottawa, Ontario, and examines sociodemographic associations with negative attitudes toward public breastfeeding.

METHODS:

Data from the 2015 Rapid Risk Factor Surveillance System (RRFSS), a population health telephone survey, were obtained for Ottawa. Adults ages 18 years and older were asked whether it was acceptable for a mother to breastfeed her baby in a restaurant and shopping mall ( n = 1,276). Descriptive statistics and regression were used to describe sociodemographic characteristics associated with negative attitudes.

RESULTS:

Overall, 75% of respondents agreed that it was acceptable for a mother to breastfeed her baby in both a restaurant and shopping mall (restaurant: 78%; shopping mall: 81%). Respondents who did not have children at home, were less educated, had a mother tongue language other than French or English and who were retirees were less likely to support breastfeeding in restaurants and shopping malls. In addition, women and immigrants living in Canada for more than 15 years were less likely to support breastfeeding in shopping malls.

CONCLUSION:

Despite a law to support public breastfeeding in Ontario, there is room to improve attitudes toward public breastfeeding. Increased public support for public breastfeeding can support women and children to achieve their feeding goals, particularly for those wanting to exclusively breastfeed."

Perceptions and attitudes about body weight and adherence to the physical activity recommendation among adolescents: the moderating role of body mass index.

"Abstract:

OBJECTIVE:

We examined the associations between perceptions and attitudes about body weight and adherence to the physical activity recommendation (PAR) for adolescents to achieve ≥60 min/day of moderate-to-vigorous physical activity and tested whether body mass index (BMI) was a moderator of these relationships.

STUDY DESIGN:

Cross-sectional survey.

METHODS:

Self-reported data from Canadian adolescents (n = 4299) who participated in the 2013 Ontario Student Drug Use and Health Survey were analysed.

RESULTS:

Dissatisfaction with body weight was associated with lower odds of adherence to the PAR (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.55-0.99). More specifically, those who perceived themselves as overweight/obese had lower odds of adherence to the PAR (OR: 0.59; 95% CI: 0.42-0.81) compared with those who think they were about the right weight. Those who were trying to gain weight were more likely to adhere to the PAR (OR: 1.92; 95% CI: 1.29-2.86) compared to those who were doing nothing about their body weight. BMI was a significant moderator of the association between dissatisfaction with body weight and adherence to the PAR. At low BMI, there were no differences in the adherence to the PAR between adolescents who were dissatisfied with their body weight or not. At high BMI, adolescents who were dissatisfied with their body weight were less likely to adhere to the PAR than those who were not dissatisfied with their weight. Results were not different between males and females.

CONCLUSIONS:

Results suggest that adolescents who are dissatisfied with their body weight have lower adherence to the PAR, particularly those who are overweight or obese."

SETTING:

Falls incur significant health and economic costs, particularly among older adults. Physical activity has been found to be the single most important fall prevention behaviour an older adult can do. This manuscript describes Ottawa Public Health's (OPH) experience implementing the Better Strength, Better Balance! (BSBB) program, a fall prevention exercise program for older adults, through an innovative partnership with the local Recreation, Cultural &amp; Facility Services (RCFS) Department. BSBB aims to reach 1300 community-dwelling adults (aged 65 years and older) per year through approximately 86-130 exercise programs. Designed as a universal program, BSBB addresses participation barriers such as transportation, cost and location. BSBB was enabled with funding from the Champlain Local Health Integration Network, and coincided with the implementation of an Older Adult Plan for the City of Ottawa.

INTERVENTION:

BSBB is a beginner-level, fall prevention exercise and education program that takes place twice a week, over 12 weeks. Certified RCFS instructors delivered the exercise components of the program and OPH staff incorporated fall prevention messaging and conducted the evaluation.

OUTCOMES:

The formative evaluation indicated that participants experienced improved strength and balance, decreased fear of falling and the intent to adopt new fall prevention behaviours following the program. The partnership between OPH and RCFS allowed both partners to leverage their unique and mutual strengths to continually improve the program.

IMPLICATIONS:

Improving access to strength and balance programming is an important public health strategy to reduce falls. The recreation sector is an ideal partner to help public health in this pursuit."

The burden of alcohol-related morbidity and mortality in Ottawa, Canada.

"Abstract:

OBJECTIVES:

Alcohol-related morbidity and mortality are significant public health issues. The purpose of this study was to describe the prevalence and trends over time of alcohol consumption and alcohol-related morbidity and mortality; and public attitudes of alcohol use impacts on families and the community in Ottawa, Canada.

METHODS:

Prevalence (2013-2014) and trends (2000-2001 to 2013-2014) of alcohol use were obtained from the Canadian Community Health Survey. Data on paramedic responses (2015), emergency department (ED) visits (2013-2015), hospitalizations (2013-2015) and deaths (2007-2011) were used to quantify the acute and chronic health effects of alcohol in Ottawa. Qualitative data were obtained from the "Have Your Say" alcohol survey, an online survey of public attitudes on alcohol conducted in 2016.

RESULTS:

In 2013-2014, an estimated 595,300 (83%) Ottawa adults 19 years and older drank alcohol, 42% reported binge drinking in the past year. Heavy drinking increased from 15% in 2000-2001 to 20% in 2013-2014. In 2015, the Ottawa Paramedic Service responded to 2,060 calls directly attributable to alcohol. Between 2013 and 2015, there were an average of 6,100 ED visits and 1,270 hospitalizations per year due to alcohol. Annually, alcohol use results in at least 140 deaths in Ottawa. Men have higher rates of alcohol-attributable paramedic responses, ED visits, hospitalizations and deaths than women, and young adults have higher rates of alcohol-attributable paramedic responses. Qualitative data of public attitudes indicate that alcohol misuse has greater repercussions not only on those who drink, but also on the family and community.

CONCLUSIONS:

Results highlight the need for healthy public policy intended to encourage a culture of drinking in moderation in Ottawa to support lower risk alcohol use, particularly among men and young adults.